one years, were contracted from a young girl by attempted intercourse, and was contracted from another boy. The writer has seen several cases of gonorrhea in boys ranging from eighteen months to ten years and older; in the cases under six years it has not been possible to determine the source. Important as it is to make thorough search, in a suspected case, for the gonococcus in order to establish the fact that the organism found present, by microscopic examinations and by culture experiments, corresponds in every respect with the known properties of the gonococcus of Neisser, still even then, in medicolegal cases, the time has not come when it can be used alone as an absolute test, but it may be introduced as one fact in a chain of evidence. A. Haberda1 has made some important experiments bearing on legal medicine. He allowed pus in different thicknesses of drops to dry upon small pieces of linen, and sought to establish―(1) Whether by microscopic examination the gonococci could be recognized by means of its form, size, position, and peculiarity to coloring-agents in these dried spots, and for how long a time it would be possible to recognize them. (2) Whether from such dry spots they could be cultivated by the Wertheim method. (3) Whether such pus could cause gonorrhea. He discovered that-(1) In thick drops it was possible to recognize the gonococcus after eight months; in thinner layers there was a limit of from days to weeks. (2) Culture-media remained sterile after the secretions had thoroughly dried. (3) The gonococcus seems to lose its virulence and to be incapable of producing a gonorrhea after thorough drying of the secretions. Syphilis. The new era of medicine has added as yet but little to our knowledge of the effects or of the treatment of this disease, but the same close, careful, painstaking observations have gone on here as well as in other departments of medicine. That it is a disease of microbic origin is generally believed, but the agent has as yet eluded all efforts to recognize it. Some old theories have been overthrown; new light has been let in here and there, but it can hardly be claimed that one forward step has been taken in the last ten years. That the disease is one of the most far-reaching in the social fabric is not to be gainsaid, for, aside from the fact that although in the majority of instances it is acquired by sexual contact with one suffering from the active manifestations of the disease, it may be acquired in the most innocent manner, the length of time which elapses between the time that the disease is implanted and the time that it first manifests itself in the form of the chancre or initial lesion, frequently makes it difficult to trace the source. Further, the chancre may be so situated, or be of so slight a character, that it may be overlooked, and the disease may not be recognized until the so-called secondary manifestations appear. Thus a much longer period may pass by, making it still more difficult to trace the source. The public still needs education on many points in order to avoid needless exposure to contagion, and the most important duty on the part of the physician is faithfully to drill his 1 Centralblatt für Gynäkologie, 1895, p. 145. infected patient on the means he should employ to lessen the danger of giving the disease to others. Such persons, unfortunately, are very apt to be careless and forgetful, even though they would not knowingly convey the disease to others. A young man having syphilis, while in company, playfully applied the lighted end of his cigar to the lips of a young woman; filled with remorse at his brutal horseplay, he tenderly kisses her on the burned spot, and she later develops a chancre at that place. A sailor, with mucous patches in his mouth, tattooes a number of young men, moistening the tattooing needles by passing them over his tongue, and they each later develop a chancre at the site of the tattooing. A lady, while in her kitchen, tastes from the same spoon as does her syphilitic cook and develops a chancre of the lip. Barbers' razors and clippers, dental instruments, surgeons' instruments, towels, pipes, and numerous other articles have all been the means of conveying syphilis to innocent persons. Healthy children, from being promiscuously kissed by relatives or strangers, have been found to acquire syphilis from a known or an unknown source. The most important questions in syphilis are in relation to marriage and its effects upon the offspring. In considering these questions it is well to consider its effects in men, in women, and upon their offspring. In considering the effects of syphilis in a man the main interest centers about two questions: Can he infect his wife? Will his children show the effects of the disease? While he shows active manifestations of the disease there can be no question of the danger of infecting the wife. The most active sources of contagion are secretions from the initial lesion and from mucous patches in the mouth, the blood, and the secretions from the skin-lesions. As time passes these lesions may disappear; still the blood remains a possible source of danger. The disease may slumber, show no signs, then break out again. In a general way, the older the disease, the less effect it has upon the bearer, and the more thorough the treatment, the less danger there is that the wife will be infected. Later, long after symptoms have ceased, he may be the bearer of another class of lesions. These, generally speaking, are no longer contagious, although some cases have been reported, which appear to be open to doubt, especially where late buccal lesions have occurred by which a wife has apparently been infected. In reports of this kind it is absolutely necessary to subject them to the closest scrutiny before accepting the probability of contagion from such a source, for it is far easier to conceive the possibility of the wife being exposed to a more recent syphilis, whether innocent or illicit, than it is to conceive such a lesion to be contagious. Dr. Otis's famous case, which need not be written out, shows how easy it is to accept the apparent, and what difficulties surround the getting at the true, cause. 1 The second question involves the possibility of inheritance of the disease by the child from the father through the seminal fluid, without the mother being affected: First, sterility in the father may be due to syphilis; this almost always is amenable to treatment, and need not be 1 Clinical Lectures on Syphilis and the Genito-urinary Diseases, 1888, p. 47. considered. Second, there seems to be no question that paternal syphilis may affect the offspring without the mother being infected, and that, too, long after the time when it has ceased to show active signs in the father. The physiologic secretions, if not mixed with secretions coming from pathologic lesions, are supposed to be innocuous, and attempts to inoculate syphilis from the seminal fluid have failed; still this is no proof that, along with the impregnating spermatozoa, the syphilitic germ may not be implanted with it. That non-contagious syphilitic manifestations may be conveyed to the child from the father is easy to conceive, but when a child is actively syphilitic, capable of infecting others, then accidental infection of the child from a fresher source must be absolutely eliminated before this can be charged to the father's account. Syphilis in Women.-Like the husband, a woman may acquire syphilis before marriage; she may be infected by the husband before conception, or she may be infected by the husband after conception. If infected before marriage or by the husband before conception, the results are easily understood and accounted for. In general, syphilis, in its effects upon the woman, does not seem to be so severe as in man, but the effects on the offspring are more pronounced. Women may remain sterile or abort repeatedly; they may have still-born children or syphilitie children as a result of infection. Treatment and time have an attenuating effect. At the same time that these phenomena occur women may not show active effects of syphilis in their person, and this is one of the curious phenomena of the disease. A woman may bear a syphilitic child; she may suckle it and fondle it, and yet at no time show any syphilitic manifestations, and still the child may be a source of danger to others. This is known as Colles's law. The explanations are: (1) That she has a latent syphilis (Fournier). (2) That she is immunized, by absorption of serum, toxins, and antitoxins, through the placenta (Finger). (3) Inasmuch as she is capable of having tertiary manifestations later, there is absorption of toxins through the placental circulation, which places her in the position of one who has gone through the secondary stage, and leaves her at the tertiary stage; that is, she has a latent tertiary syphilis (von Dühring). Further, a woman may give birth to a syphilitic child, and, by suckling it, receive infection by having a chancre of the nipple, an exception to Colles's law. Such cases have been observed by Guibout, Rouse, Scarenzie, Lucas, and many others. At the same time, in investigating nch cases, a fresh, acquired syphilis on the part of the child must be eliminated. Further (Morrow), women have borne syphilitic children from a syphilitic father, and healthy children from a healthy father, without showing signs of the disease. Effects in Children.-Absolutely healthy children have been born of actively syphilitic parents, and have never shown the effects of the disease, and children have been born healthy, and years after have shown tertiary manifestations, or they have been born healthy and shortly after birth shown syphilitic disease. Children born of a syph ilitic mother have remained healthy although she suckled them while she was actively syphilitic, and still have remained healthy, or late in life (eighteen to twenty years) have manifested tertiary lesions. This is known as Bofetas's law; it is the reverse of Colles's, and is explainable by immunization through the placental circulation. Children may be born having active syphilis, and be capable of infecting others, or they may have lesions which, to the eye, are the same, and yet be incapable of infecting others. The cases where a healthy nurse has been infected by a syphilitic child through suckling it are rare, yet entirely possible, and are to be feared when a syphilitic child is to be nourished by a wet-nurse. The question on this very point may arise, whether the child has infected the woman or the woman has given syphilis to the child. The following may be the case: (1) The nurse may be actively syphilitic and infect the child, and yet show no active signs. (2) She may have a chancre of the nipple derived from a previous nursing. (3) She may be infected by a syphilitic child. (4) The child may get a chancre of the lip from being kissed by a syphilitic person, and infect the nurse by causing chancre of the nipple. (5) The nurse may get the chancre of the nipple from an outside source. Syphilis has recently been adjudged a ground for divorce in France. If innocently acquired, it is difficult to see where there is any more justice in granting divorce for syphilis than for tuberculosis when it has occurred after marriage. If acquired from sexual contact, unless the partner in marriage also has it, it is presumptive of adultery, and therefore, ground for divorce. 1 Barker, Edinburgh Medical Journal, June, 1896, p. 1124. MARRIAGE AND DIVORCE. BEFORE discussing the medicolegal topics that are usually comprised under this head it is necessary to review briefly the marriage institution from a purely legal standpoint. Marriage at its inception is a contract: it can be entered upon like any other contract, and is, to a certain degree, subject, like other contracts, to indispensable and prerequisite conditions as to parties, consideration, subject-matter, and assent. It may be said in general that immediately upon the consummation of this contract, in which the state is deemed to be a silent participant, there is created among these three— namely, the two spouses and organized society a status of mutual rights and duties. This is to some extent true even as to those marriage contracts which can be avoided legally. But the law endeavors to strengthen a valid marriage, and even tends to validate, under certain conditions, some marriages that might become voidable; and it is not only by the statute, but also by judicial precedent, that "the law favors marriage." As a consequence of this peculiar triangular relation, marriage, whether considered as a contract or as a status, differs materially in its legal incidents and effects from ordinary contracts. Thus, the common grounds for voiding and rescinding other contracts, such as duress, fraud, and incompetency, have frequently less force and are more readily deemed waived in the case of marriage; and even for certain gross frauds effected by false antenuptial representations as to health, temperament, social position, or worldly estate, the law affords no relief whatever. Among elements or consequences of this status may be noted the right to dower and courtesy; the incident of privileged marital communications; the doctrine of the wife's right of support and the corresponding duty of the husband to supply her with necessities; the voiding of deeds, wills, and contracts that would operate in restraint of marriage; and the peculiarities of divorce and procedure. Broadly stated, the object of the state in interfering with the marital relation when once established is the protection of the family and the preservation and improvement of the species. The state does not, however, as a rule, attempt to regulate the relation before it arises. The general, almost universal, absence of such regulation has been a fruitful theme of discussion. That the breeding of the human race should be, as it is in most instances, so fortuitous and anarchic, is at first glance shocking to the reason; but upon further examination the difficulty of effecting any change from the present system-or no system-will become readily apparent. And yet, it is to be hoped that the legal authorities VOL. II.-11 161 |